Agarwal Jay, Wong Anni, Karle William, Naunheim Matthew, Mori Matthew, Courey Mark
Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, Mount Sinai Health System, New York, New York, U.S.A.
Laryngoscope. 2019 May;129(5):1067-1070. doi: 10.1002/lary.27697. Epub 2019 Jan 2.
OBJECTIVES/HYPOTHESIS: Optimal treatment for patients with vocal fold polyps (VFPs) remains controversial. We compared the short-term outcomes of treatment with voice therapy alone (VT), surgery alone (SUR)m or voice therapy and surgery (VTS).
Retrospective case series.
A retrospective study was performed for patients diagnosed with VFP (International Classification of Diseases, Ninth Revision code 478.4 and Tenth Revision code J38.1) between January 2010 and April 2016. Inclusion criteria were age greater than 18 years and charted evidence of treatment with voice therapy, surgery, or both. Exclusion criteria were history of laryngeal cancer or radiation above the clavicles. Outcomes measured included chart records of lesion absence, persistence or recurrence, and differences between pretreatment and post-treatment Voice Handicap Index-10 and GRBAS (G/grade, R/roughness, B/breathiness, A/asthenia, S/strain) scores.
One hundred twenty patients with VFPs were identified (SUR = 23, 19.2%, VT = 29, 24.2%, VTS = 68, 56.7%). Mean follow-up was 5.5 months. There were no recurrences in 115 patients (95.8%). There was significant improvement from pre- to post-treatment VHI-10 scores in the SUR (mean improvement = 12.5, standard deviation [SD] = 12.7) and VTS (mean improvement = 12.3, SD = 10.3) groups compared to the VT (mean improvement = 2.84, SD = 11.9) group (P = .009). Pre- and post-treatment GRBAS scores did not significantly change in any group.
When using patient-reported outcomes measures, patients with VFPs receive the greatest short-term gains from treatment paradigms involving surgery or a combination of surgery and voice therapy. Voice therapy alone did not result in significant short-term changes. Perceptual voice characteristics did not change significantly for any group. Further research on long-term treatment outcomes for patients with VFPs is needed.
3 Laryngoscope, 129:1067-1070, 2019.
目的/假设：声带息肉（VFP）患者的最佳治疗方案仍存在争议。我们比较了单纯嗓音治疗（VT）、单纯手术（SUR）或嗓音治疗与手术联合（VTS）的短期治疗效果。
回顾性病例系列研究。
对2010年1月至2016年4月期间诊断为VFP（国际疾病分类第九版编码478.4和第十版编码J38.1）的患者进行回顾性研究。纳入标准为年龄大于18岁且有嗓音治疗、手术或两者治疗记录的证据。排除标准为喉癌病史或锁骨以上放疗史。测量的结果包括病变消失、持续或复发的病历记录，以及治疗前和治疗后嗓音障碍指数-10（VHI-10）和GRBAS（G/分级、R/粗糙、B/气息声、A/无力、S/紧张）评分的差异。
共确定120例VFP患者（SUR组23例，占19.2%；VT组29例，占24.2%；VTS组68例，占56.7%）。平均随访时间为5.5个月。115例患者（95.8%）无复发。与VT组（平均改善2.84，标准差[SD]=11.9）相比，SUR组（平均改善12.5，SD=12.7）和VTS组（平均改善12.3，SD=10.3）治疗前至治疗后的VHI-10评分有显著改善（P=0.009）。任何组的治疗前和治疗后GRBAS评分均无显著变化。
在使用患者报告的结局指标时，VFP患者从涉及手术或手术与嗓音治疗相结合的治疗模式中获得的短期收益最大。单纯嗓音治疗未导致显著的短期变化。任何组的嗓音感知特征均无显著变化。需要对VFP患者的长期治疗效果进行进一步研究。
3 喉镜，129:1067 - 1070，2019年。
